Hawai'i PRAMS Project Summary The Hawai'i Pregnancy Risk Assessment Monitoring System (PRAMS) Program is a population-based surveillance system designed to identify and monitor maternal experiences, attitudes, and behaviors from preconception, through pregnancy and into the interconception period. PRAMS provides ongoing monitoring of maternal behaviors to determine how to reduce infant deaths, decrease low birth weights and improve the overall health of the population in Hawai'i. The overall goal of Hawai'i PRAMS is to reduce infant morbidity and mortality by impacting maternal and child health programs, policies and maternal behaviors during pregnancy and early infancy. There are four PRAMS objectives: 1) Collect high quality population-based data on maternal behaviors before and during pregnancy and during the early life of the infant; 2) Conduct epidemiologic analysis and study of maternal behaviors and experiences during pregnancy and early infancy and the relationship to health outcomes; 3) Translate data analyses into useable information for program planning, monitoring and evaluation; and 4) Increase public awareness of healthy pregnancy behaviors to improve maternal health across the life span. A PRAMS questionnaire is mailed to approximately 200 new mothers per month on all major islands of Hawai'i. The new mothers are identified by the Office of Health Status and Monitoring (OHSM), Hawai'i Department of Health, from the birth certificates of recently born infants. The Hawai'i questionnaire includes questions that are asked by PRAMS programs in all states as well as standard questions selected for inclusion by the Hawai'i PRAMS Program, in partnership with the Hawai'i PRAMS Steering Committee, other Department of Health program staff, and local healthcare providers. The questionnaire addresses priority maternal and child health issues such as unintended pregnancies, smoking and alcohol use during pregnancy, insurance at time of pregnancy, contraception, post-partum depression and domestic violence. Hawai'i PRAMS standard questions address topics such as breastfeeding, dental care, drug use, general health, HIV, and maternal health conditions.